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Meta-Analysis
. 2025 May 12;25(1):689.
doi: 10.1186/s12879-025-11067-2.

Prevalence of bedaquiline resistance in patients with drug-resistant tuberculosis: a systematic review and meta-analysis

Xinyang Hu #  1 , Zhiwei Wu #  2 , Jing Lei  1 , Yanqin Zhu  1 , Jingtao Gao  3
Affiliations
Meta-Analysis

Prevalence of bedaquiline resistance in patients with drug-resistant tuberculosis: a systematic review and meta-analysis

Xinyang Hu et al. BMC Infect Dis. .

Abstract

Background: Drug-resistant tuberculosis (TB) remains a major global public health challenge. While bedaquiline (BDQ) offers improved treatment outcomes for patients with multi-drug resistant TB (MDR-TB), its widespread use has led to the emergence of BDQ resistance.

Methods: This systematic review evaluated the prevalence of BDQ resistance among adult patients through searches of PubMed, Web of Science, and Embase databases. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity and compare prevalence estimates across groups. The Joanna Briggs Institute's quality assessment checklist was used to evaluate the methodological quality of the included studies. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests.This study is registered with PROSPERO, CRD42024620791.

Results: The weighted average prevalence of BDQ resistance was 5.7% (95% CI: 3.6-8.3), with acquired resistance reported at 5.4%. Geographic differences were observed, with South Africa showing a higher prevalence (10.4%) compared to China (2.4%).High-quality studies reported a prevalence of 5.2%, while fair-quality studies reported 7.7%. Mutations in the Rv0678 gene represented a significant proportion, reaching as high as 65.6%.

Conclusions: Our findings highlight an increasing trend in acquired resistance to BDQ, offering critical insights for managing MDR-TB. The application of whole-genome sequencing shows promise for advancing understanding of drug resistance mechanisms in Mycobacterium tuberculosis.

Keywords: Acquired bedaquiline resistance; Bedaquiline resistance; Meta-analysis; Systematic review; Tuberculosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the studies selection process
Fig. 2
Fig. 2
The prevalence of BDQ resistance in study periods
Fig. 3
Fig. 3
The prevalence of BDQ resistance in studies of different qualities
Fig. 4
Fig. 4
The prevalence of BDQ resistance in studies of different years
Fig. 5
Fig. 5
The prevalence of BDQ resistance in studies of different countries
Fig. 6
Fig. 6
The prevalence of acquired BDQ resistance in studies
Fig. 7
Fig. 7
The prevalence of Rv0678 gene mutation in studies
Fig. 8
Fig. 8
Funnel plot of the risk of publication bias
See this image and copyright information in PMC

References

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    1. Mahajan R, Bedaquiline. First FDA-approved tuberculosis drug in 40 years. Int J Appl Basic Med Res. 2013;3(1):1–2. - PMC - PubMed
    1. WHO Guidelines Approved by the Guidelines Review Committee. The Use of Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis: Interim Policy Guidance. Geneva: World Health Organization Copyright © World Health Organization 2013.; 2013.
    1. WHO Guidelines Approved by the Guidelines Review Committee. Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis. Geneva: World Health Organization Copyright © World Health Organization 2014.; 2014. - PubMed
    1. WHO Guidelines Approved by the Guidelines Review Committee. WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update. Geneva: World Health Organization Copyright © World Health Organization 2016.; 2016.

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